Healthcare Provider Details

I. General information

NPI: 1023354743
Provider Name (Legal Business Name): PHYLLIS ANNETTE GERBER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2012
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 S HIAWASSEE RD STE 210
ORLANDO FL
32835-5719
US

IV. Provider business mailing address

5036 DR PHILLIPS BLVD STE 333
ORLANDO FL
32819-3310
US

V. Phone/Fax

Practice location:
  • Phone: 407-298-5400
  • Fax: 407-298-8006
Mailing address:
  • Phone: 941-356-9434
  • Fax: 941-918-0401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License NumberME 66305
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberME 66305
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 66305
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: